RESUMO
BACKGROUND: Verbal learning and memory deficits are frequent among patients with schizophrenia and correlate with reduced magnetic resonance imaging (MRI) volumes of the hippocampus in these patients. A crucial question is the extent to which interrelated structural-functional deficits of the hippocampus reflect a vulnerability to schizophrenia, as opposed to the disorder per se. METHOD: We combined brain structural measures and the Rey Auditory Verbal Learning Test (RAVLT) to assess hippocampal structure and function in 36 never-medicated individuals suspected to be in early (EPS) or late prodromal states (LPS) of schizophrenia relative to 30 healthy controls. RESULTS: Group comparisons revealed bilaterally reduced MRI hippocampal volumes in both EPS and LPS subjects. In LPS subjects but not in EPS subjects, these reductions were correlated with poorer performance in RAVLT delayed recall. CONCLUSIONS: Our findings suggest progressive and interrelated structural-functional pathology of the hippocampus, as prodromal symptoms and behaviours accumulate, and the level of risk for psychosis increases. Given the inverse correlation of learning and memory deficits with social and vocational functioning in established schizophrenia, our findings substantiate the rationale for developing preventive treatment strategies that maintain cognitive capacities in the at-risk mental state.
Assuntos
Hipocampo/fisiopatologia , Transtornos da Memória/fisiopatologia , Testes Neuropsicológicos/estatística & dados numéricos , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Transtorno da Personalidade Esquizotípica/fisiopatologia , Adulto , Estudos Transversais , Progressão da Doença , Dominância Cerebral/fisiologia , Feminino , Hipocampo/patologia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Programas de Rastreamento , Transtornos da Memória/diagnóstico , Transtornos da Memória/psicologia , Rememoração Mental/fisiologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Psicometria/estatística & dados numéricos , Reprodutibilidade dos Testes , Retenção Psicológica/fisiologia , Fatores de Risco , Esquizofrenia/diagnóstico , Transtorno da Personalidade Esquizotípica/diagnóstico , Aprendizagem Verbal/fisiologiaRESUMO
Optimum therapy of streptococcal pharyngitis is still a matter of great debate. Kill kinetics of streptococci group A were investigated under the influence of fluctuating concentrations of penicillin V, ampicillin, cefalexin and erythromycin. Antibiotic concentrations in our in vitro model were adjusted to concentrations found in vivo in tonsillar tissue, penicillin V showed superior antimicrobial activity to ampicillin, cefalexin and erythromycin. Only the eight hourly administration of concentrations determined after the in vivo administration of either 100,000 IU/kg BW penicillin or 100 mg/kg BW of ampicillin or cefalexin effectively eradicated streptococci in the kinetic model. beta-lactamase forming bacteroides did not interfere with the elimination of streptococci by non beta-lactamase stable antibiotics. These data suggest that penicillin V constitutes the optimum choice of antibiotic. Efficient eradication can be achieved by the administration of a total daily dosage of 100,000 IU/kg BW at 8 hourly intervals.
Assuntos
Antibacterianos/administração & dosagem , Faringite/tratamento farmacológico , Infecções Estreptocócicas/tratamento farmacológico , Tonsilite/tratamento farmacológico , Tonsila Faríngea/metabolismo , Antibacterianos/farmacocinética , Criança , Esquema de Medicação , Humanos , Tonsila Palatina/metabolismo , Streptococcus pyogenes/efeitos dos fármacosRESUMO
We examined the influence of induction chemotherapy integrated with surgery and postoperative radiotherapy on 5-year treatment results of 107 patients suffering from advanced head and neck carcinomas. The chemotherapy regimen consisted of one to three cycles of a combination of cisplatin, methotrexate and bleomycin. The overall response rate to induction chemotherapy was 58% with a 26% complete response rate. Using actuarial life tables, survival was 44% for all patients. The initial tumor stages were found to be predictive for patients' responses to chemotherapy as well as for their survivals. The overall response rate was 65% for T-3 tumors vs 29% for T-4 tumors. Five-year survival was 54% for T-3 vs 24% for T-4 tumors. The other predictive factor for survival was response to chemotherapy. Five-year survival was 73% for those patients achieving a complete response vs 17%-37% for patients with any residual disease after drug treatment. Since a favorable response to chemotherapy was strongly associated with a lesser T-stage as well as with significantly better survival of patients in our study, we conclude that induction chemotherapy may best benefit those patients with smaller tumors. Our findings show that a complete response to chemotherapy can also serve as a good prognostic sign, although an a priori better prognosis is still associated with patients who have smaller tumors.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Adulto , Idoso , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Terapia Combinada , Feminino , Humanos , Metástase Linfática , Masculino , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , PrognósticoRESUMO
We studied the nutritional and immunological states of 20 patients with advanced head and neck carcinomas. Treatment included chemotherapy with methotrexate, cis-platinum and bleomycin prior to operation and radiotherapy. Nutritional and immunological parameters were examined before and after each therapy given. Most of these parameters decreased during chemotherapy. However, while we found that nutrition improved or normalized by the end of the primary tumor treatment, immunologic parameters failed to change significantly.